Provider Demographics
NPI:1124028261
Name:GALIK, ELIZABETH MARIE (RN CRNP PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:GALIK
Suffix:
Gender:F
Credentials:RN CRNP PHD
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:SHEPPARD PRATT, GIBSON BUILDING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-4981
Mailing Address - Fax:410-938-5310
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:SHEPPARD PRATT, GIBSON BUILDING
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-4981
Practice Address - Fax:410-938-5310
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR121770363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD126651900Medicaid
MD126651900Medicaid
S77999Medicare UPIN